MR. CHAIRMAN: Good afternoon everyone. Welcome to the Standing
Committee on Veterans Affairs. I'm Derek Mombourquette, the MLA for Sydney-
Whitney Pier, and I'm the Chair of the committee. Today, we will be receiving a
presentation regarding the Camp Hill Veterans' Memorial Hospital.

I want to remind those in attendance to please turn your phones to
silent or vibrate. After we go through the presentation and get into questions,
I just ask the presenter to let me recognize you before you answer, just for
Hansard. We also have a number of items of committee business to deal with
after the presentation today.

I'd like to ask members to introduce themselves before we move on to
the presentation.

[The committee members introduced themselves.]

MR. CHAIRMAN: I'd like to introduce Ms. Lindsay Peach, who is the
Vice-President of Integrated Health Services with the Nova Scotia Health
Authority. I now pass the floor over to you for your presentation.

MS. LINDSAY PEACH: Thank you for the opportunity to join you today.
For the Nova Scotia Health Authority, it's certainly a privilege for us to be
able to provide care and support to veterans, who have served our country so
well.

On behalf of the Nova Scotia Health Authority, I'm pleased to be
able to speak to you about one of the ways in which we provide that care
through our long-term care services. As you know, we're not able to speak on
behalf of Veterans Affairs Canada. What I am able to share with you today,
though, is the relationship that the Nova Scotia Health Authority currently has
with Veterans Affairs Canada and more specifically how that applies to the Camp
Hill Veterans' Memorial Building.

I understand that your interest relates to Camp Hill specifically,
and I believe that that's best understood within the broader context of
services to veterans in Nova Scotia. To that end, I thought I'd begin with some
context and perspective, followed by a general overview as to how veterans in
Nova Scotia currently access long-term care services. From there, we'll move
into a discussion of the role of the Nova Scotia Health Authority specifically
in providing long-term care to veterans and then move into a specific
discussion related to Camp Hill, including the new agreement that was recently
reached between Veterans Affairs Canada and the Nova Scotia Health Authority.
Following that, I'm pleased to take any questions or have any discussion that
you might want to have.

There's several points in terms of context and perspective that I
wanted to start by sharing with you today. The first point is that Veterans
Affairs Canada, or VAC - and you'll see that terminology used throughout the
presentation - financially supports veterans in long-term care facilities
throughout Nova Scotia. This includes contract beds in facilities like Camp
Hill or the Northumberland Veterans Unit, or in community nursing homes in
communities across the province. As I understand from Veterans Affairs Canada,
there are currently 476 veterans in Nova Scotia receiving long-term care. Of
those, 280 - or 59 per cent - currently receive that care in contract beds; and
196 - or 41 per cent - are receiving that care in community long-term care
facilities across the province.

The second point that I wanted to mention is that Veterans Affairs
Canada provides long-term care in the province through contract providers -
there are four in total and of those, the Nova Scotia Health Authority is the
largest. We have 94 per cent of the contract beds in the province.

The third point I wanted to mention is that the eligibility for
services and programs offered by Veterans Affairs Canada is determined by them.
As a service provider, we do not determine eligibility. As well, I wanted to
note that provincial policies related to long-term care placement do not apply
to the Veterans Affairs Canada contract beds, and I can get into that a little
bit later.

The fourth point to mention is that we're not able to speak to the
policies of Veterans Affairs Canada or able to speak on their behalf. What I
can speak to is the relationship that we have with them as one of the service
providers and how those policies apply to us.

In terms of access to long-term care services for veterans in Nova
Scotia, as I said, Veterans Affairs Canada determines the criteria and has a
process in place to determine eligibility for long-term care. They provide
financial support to individuals who require that service, whether it's in a
contract bed like at Camp Hill which we'll be talking about today, or in a bed
in a community-based facility across the province.

Factors Veterans Affairs Canada takes into consideration when they
determine that eligibility include a veteran's health care needs: if they are
able to be supported in the community or if they require placement in a long-term
care facility; what their service-related disability would be; what their
income would be to determine any contributions that the veteran may make to the
care; and the military service that the individual has had as well.

As I mentioned, once eligibility for long-term care has been
determined by Veterans Affairs Canada, they do provide support for the veteran
to access that service in one of two ways. The first way, and one that's
probably less frequently discussed, is community beds. These would be beds
located in long-term care facilities and communities across the province that
provide care to veterans as well as to community clients. As of last week,
there are 196 veterans across the province receiving care in this way. Access
to these beds is coordinated through the provincial single-entry access system,
and for veterans who are receiving that care, Veterans Affairs Canada funds 100
per cent of the cost of care.

The benefit of enabling veterans to access beds in community
facilities is it does enable veterans to have choice in where they live, so
some veterans would have a facility preference, for instance. It would also
allow them to be as close to home as possible. Our Veterans Affairs Canada
contract beds only exist in certain communities across the province, so
allowing them to access long-term care in our community-based facilities
provides them that option. It does also allow them to be collocated with a
non-veteran spouse or another family member.

The second way that Veterans Affairs Canada provides support to
veterans requiring long-term care is through contract beds, and that's often
the option that's discussed. These would be designated beds located in
facilities that provide priority access for eligible veterans, again, eligible
veterans as determined by Veterans Affairs Canada. Right now, for contract
beds, that would include World War II and Korean War veterans; there is another
access point for Camp Hill, which I'll discuss later. Access to these beds is
coordinated by Veterans Affairs Canada, as is the eligibility for that. As of
last week, there were 280 veterans receiving care in this way across the
province.

Of the second category of ways that veterans can receive long-term
care in the province, the contract beds, there are four providers in the
province, as I had indicated, that provide this level of service: Nova Scotia
Health Authority, with 314 beds; High-Crest Springhill nursing home in Springhill,
with 10 beds; St. Anne Community and Nursing Care Centre in Arichat, with 5
beds; and Wynn Park Villa in Truro, with five beds.

More specifically, getting into the details of the role of the Nova
Scotia Health Authority in providing those contract beds, of the 314 Veterans
Affairs Canada contract beds that the Nova Scotia Health Authority operates,
175 are located at Camp Hill in Halifax; 31 of those are located at Taigh Na
Mara in Glace Bay; 20 are at Harbour View Hospital in Sydney Mines; 5 are at St.
Martha's Regional Hospital in Antigonish; 20 are at the Northumberland Veterans
Unit in Pictou; 23 at the Fishermen's Memorial Hospital in Lunenburg; 25 at Soldiers'
Memorial Hospital in Middleton; and 15 at Veteran's Place in Yarmouth.

As I'd indicated, we do have an occupancy rate in some of these
facilities. Right now, these beds are about 85 per cent occupied across the
province. I do have the occupancy by facility if you're interested in knowing
that. The total budget combined that we receive from Veterans Affairs Canada to
operate those beds is $41.8 million. The per diem ranges from $249 to $397,
depending on the facility.

Moving, then, into a specific discussion around Camp Hill - Camp
Hill was formerly a veterans hospital. It was transferred to provincial
jurisdiction in 1978, under the terms of the Camp Hill transfer agreement. Since
that time, Veterans Affairs Canada has continued to serve as both a funder and
as a collaborator. This agreement was updated in 1992, as a master agreement
between the province, the Nova Scotia Health Authority - actually its
predecessor organizations - and facilities to provide long-term care.

It's important to note that Camp Hill is a long-term care residence
for veterans. While we do provide nursing and medical care, for certain, for
veterans, it is not a hospital. Camp Hill itself is comprised of 175 beds
located across seven units that provide priority access to veterans in need of
long-term care. They do provide us with an annual operating budget of $25.4
million - that was the budget for 2015-16 - and that translates into a per diem
of $397 per day for those beds.

In addition to the nursing care that's provided at Camp Hill, it's
important to note that the services there also provide a broad
interdisciplinary team of support, including respiratory therapy,
physiotherapy, occupational therapy, recreation therapy, social work,
psychology, and spiritual care. It is a broad-based team support. The other
thing I need to note is that Camp Hill also enjoys an amazing amount of support
from local Legions, military organizations, veteran support organizations, and
volunteers. It's quite amazing to see the support and involvement of the local
community in that facility.

Camp Hill is not licensed as a long-term care facility by the
Department of Health and Wellness. However we do hold ourselves to the standards
established by Accreditation Canada, the long-term care standards, so we are
nationally accredited. The last survey would have been done in April 2014 as
part of the Capital Health process at that time, and we received exemplary
status from Accreditation Canada. We also do ongoing surveys of the veterans
who are residing in the facility to determine their level of satisfaction and
make adjustments as we need to.

The utilization of Camp Hill beds - this is the breakdown as of July
4th. Of the 175 beds at Camp Hill, 150 are occupied by veterans. We
do have a number of beds at the facility that are occupied by patients who have
temporarily relocated due to the Dartmouth General redevelopment. There is an
agreement in place with Veterans Affairs Canada that allows us to use beds when
they're not needed by them for temporary purposes. We do have 12 beds that are
unoccupied. The unoccupied beds are largely located on two of the seven units.

Given the number of sustained vacancies that we've had at Camp Hill,
an opportunity was identified to explore ways in which the capacity could be
used to meet the long-term care needs of other veterans. While we've seen a 43
per cent reduction in the wait-list for long-term care since April 2015, we do
continue to experience wait-lists for long-term care in Nova Scotia, and that
was having an impact on veterans' access and care.

On June 24th of this year, Nova Scotia Health Authority
and Veterans Affairs Canada reached a new agreement to expand access to Camp
Hill for veterans requiring long-term care. Again, just like the contract beds,
eligibility for this access is determined by Veterans Affairs Canada. Veterans
that are eligible under the Veterans Health Care Regulations for care in a
community facility other than a contract bed would be eligible for accessing
care under this new agreement at Camp Hill.

Under the new agreement, Veterans Affairs Canada will be responsible
for determining the eligibility and assessing the needs of a new cohort of
veterans. This is similar to our relationship with them regarding contract
beds. We have also agreed that we would work together to ensure that veterans
admitted under this new agreement will receive the same high standard of care
currently offered at Camp Hill. While we are currently working out the details
and the process to operationalize the agreement, we were able to accept the
admission of our first resident on June 29th under this new
agreement.

I think that concludes the formal part of the presentation. I'm now
happy to take questions you might have.

MR. CHAIRMAN: Thank you. We'll start with questions. Mr. Wilson.

HON. DAVID WILSON: Thank you for coming here today and for giving us
an update. I understand your limitations on speaking on behalf of Veterans
Affairs Canada, but of course, over the last number of months especially, there
has been a lot of attention around vacancies at Camp Hill and the ability for
veterans to gain access to those beds.

This new agreement, which I see was reached on June 24th
- I know the criteria are with Veterans Health Care Regulations. Do you know
what that is? Are you able to provide the committee that regulation? I think
that would clear up some of the questions that many families out there have
about access to it. If there's a new agreement, and they've changed
regulations, is the province able to provide that to the committee today or
over the next few days?

MS. PEACH: My understanding from Veterans Affairs Canada - and
again, I can't speak for them - is that this new agreement that we have in
place with them did not require a change in their health care regulations that
I referenced. So admissions to Camp Hill would be under those regulations. They
would be the best ones to provide those. They're the criteria that they utilize
for admissions both to the contract beds as well as these. It's not something
that we would have ready access to.

MR. DAVID WILSON: So the agreement really is that they're going to
use more beds at Camp Hill? I know the province has jurisdiction over the building,
the facility. Is that what you're saying here? There's a lot of confusion out
here. We've had a number of cases - Mr. Blindheim, I believe, is the first
individual to gain access after what we can assume are changes to some policy
that nobody knows about. Really, though, this is just an agreement with the
province saying that, potentially, Veterans Affairs Canada will use more of the
unoccupied beds at Camp Hill. Is that correct? Am I understanding it correctly?

MS. PEACH: Maybe if I could clarify. The Camp Hill building itself
is a resource of the province, operated by the Nova Scotia Health Authority.
The agreement that we have with Veterans Affairs is in place with us to be a
contracted service provider of long-term care on Veterans Affairs Canada's
behalf, if you want to look at it that way.

This new agreement that we've reached with them is to enable them to
utilize the 175 contract beds that are available at Camp Hill for a category of
veterans other than World War I, World War II, and Korean War veterans, as
determined by them. So it's reaching that agreement that we agree to continue
to provide that service to that new group of veterans that they identify, in
keeping with the same standards that we would have for the other veterans at
Camp Hill.

MR. DAVID WILSON: It's interesting, though. I've been paying close
attention to this, and I don't know what that new criteria is - I don't think
Nova Scotians or Canadians know - so that's the frustrating part. Hopefully you
understand that.

But they didn't request additional beds at Camp Hill - it's still
under the 175 that have been in agreement for a number of years now, right?

MS. PEACH: Yes, so it would be allowing them to use a category of
those 175 for a different purpose, as they deem fit.

I guess my question's a pretty simple question. With all that has
gone on with Mr. Blindheim's access to Camp Hill's veterans' care - I know the
Nova Scotia Health Authority operates Camp Hill, as it does all of their
long-term care facilities and the hospital - besides the funding from Veterans
Affairs Canada, what is the difference between the care that Mr. Blindheim
would have gotten if he were in one of the province's other facilities or in
Camp Hill?

MS. PEACH: Because Camp Hill is a facility that is specifically
designated to provide care and support to veterans, Veterans Affairs Canada
does provide support for other members of a broader allied health team that
would be different than other long-term care facilities across the province.
So, looking at the unique needs of the veteran population and the care that
we're providing, there are some differences in what Veterans Affairs funds us
to provide in terms of that interdisciplinary team, in comparison to other
community residences. That would be the difference.

MR. ORRELL: I guess the logical question is, what differences in
care would there be? Also, why couldn't we as a province put Mr. Blindheim in
care as a non-veteran until they straightened that away with what was going on
with Veterans Affairs Canada? Obviously he needed the care. He needed to be in
the care facility.

Putting all the other differences aside, if he needs the care, he's
going to get access to a care facility and then let both levels of government
fight out who's going to pay for it. To me, it was just ridiculous that this
poor gentleman was sitting there and two levels of government were fighting
over who was going to come and pay for it. Eventually, it's the same taxpayer
who pays for that care, so why didn't the provincial government say, put him in
one of our facilities and we'll deal with that stuff later on? Is that
something that was thought of or talked about? Is it something that happens or
doesn't happen? I guess that's my question.

MS. PEACH: It's difficult. We can't speak to the specifics of cases.

MR. ORRELL: I understand that.

MS. PEACH: It's difficult to be able to provide all of that context
when presented with them in the media as well. I think what we've endeavoured
to do is, when cases are identified, work with the family or the next of kin to
make them aware of other supports that may be available to them. As I'd
indicated, veterans can be placed in long-term care facilities across the
province, which can sometimes allow for more immediate or more ready access
close to home, and does allow for co-location with spouses.

That can take some time as well, but we certainly do try to reach out
if they are existing clients of ours to make sure they're aware of all the
options that might be available to them, but recognizing that individuals have
choice and so sometimes may prefer a particular placement over another.

MR. CHAIRMAN: Mr. Rankin.

MR. IAIN RANKIN: Just following on the same line of questioning, I'm
going to reference the other case that had some prominence - that would be Alan
Sagar. I know he's not yet ready, but the family is looking to plan ahead for
obvious reasons. The last time they had any kind of recognition that they would
get services was in 2013, and it took about eight months to get those services.
As he's in his 90s, I'm just wondering, does the Department of Health and
Wellness actually get involved while he's waiting to get some kind of
recognition? Something could happen abruptly, and if the federal government's
going to take eight months again, what's the role that the province plays in
jumping in there and ensuring that he actually has a place to go?

MS. PEACH: Again, not being able to speak to the specific cases,
it's difficult for us, unless an individual is a client of ours or reaches out
to continuing care, to offer that support. So we certainly encourage
individuals to reach out to us if there's other support that they think the
continuing care system would be able to provide to them. It makes it easier for
us to make those connections for them.

I think what we do try to do in cases like that is to identify what
supports we can provide within the provincial system and certainly answer any
of the questions they have around what supports Veterans Affairs may be able to
provide for them, as well, to the extent that we're able. In situations where
individuals want to plan ahead for their care needs, I think that's a valuable
thing for individuals to be able to do, recognizing that there is a team behind
them that looks at their current care needs and helps to try to project the
future of what that could possibly look like.

MR. RANKIN: And you mentioned that the regulations hadn't changed.
Is there appetite within the federal government to change regulations? What
would be the process there? Do they take information from military relations
within provinces? Is there someone who could provide input from our perspective
to give advice for possible regulation changes?

MS. PEACH: That would really be a question best asked of Veterans
Affairs Canada, what their plans may be for the long-term review of those
regulations.

MR. RANKIN: Okay, thanks.

MR. CHAIRMAN: Mr. MacLeod.

HON. ALFIE MACLEOD: Thank you, Mr. Chairman, and thank you, Lindsay,
for your presentation. I guess the question really on a lot of people's minds
is, as of the change of regulations on June 24th where now the
admission standards are different, if another situation came up similar to the
one that took eight months to find a solution - are you aware if this can be
avoided again? I guess what really bothers a lot of us, and I think everybody
around this table, is the fact that it took that long to actually respond to
the needs of a veteran who has served our country.

What I'm interested in, and I think everyone is interested in, is
finding out whether or not the changes in the new agreement will keep this from
happening again to somebody else.

MS. PEACH: The health care regulations haven't changed. What has
changed is the agreement that Veterans Affairs has with us. My understanding is
the applicability of that agreement, if there is a veteran who meets the
criteria that they've determined under the health care regulations, who
requires care in a long-term care facility, whereas before the subset of that
population that would be able to be supported at Veterans Affairs Canada
contract beds, like at Camp Hill - that category has expanded. They would be
able to respond in a situation like that. They determine the eligibility and
they advise us when they do have a resident who is appropriate for care in a
particular facility.

I understand that that is their intention: to be able to expand the
access to deal with situations like that.

MR. MACLEOD: Basically, we're hopeful, then - or would it be safe to
say that the health authority's hopeful - that such a situation wouldn't take
place again, understanding as much as you do about what VAC is offering for our
veterans now?

MS. PEACH: That would be my understanding, that this would provide
an option for care that may not have been in place previous to that. I think
the other important element is that there are other options for care that can
be explored as well, in community-based facilities, that sometimes individuals
may not be as aware of, that we certainly need to ensure that we're sharing
with them. Obviously the priority we would have is that individuals get access
to care when they need it, so we certainly would want to work with individuals
in cases such as that one to ensure that they're aware of the other options
that might be available to them.

MR. MACLEOD: I guess the long-term goal of everybody here is to make
sure that this eight-month period of time doesn't pass again. So the Health
Authority is willing to do as much as it can to make this happen as long as
Veterans Affairs puts a name forward in a timely fashion. Is that a fair
assessment of what's taking place?

MS. PEACH: Unless the individual is already a client of ours, the
first point of contact that we have is through Veterans Affairs Canada and
their identification of their need. So absolutely I think this new agreement
presents an option that we wouldn't ordinarily have had. The other thing I
would say for the Health Authority is, we can't insist that an individual
accept home care or long-term care. While we might make individuals aware of
options that could be available to them in the community, it is a choice that
they're able to make whether or not they choose to accept that.

MR. CHAIRMAN: Mr. Stroink.

MR. JOACHIM STROINK: Listening to your conversation today and your
presentation, it really brings light to how important the feds are in dealing
with our veterans. We should be dedicated to our veterans; they have done a lot
for this country. I guess that's what I'm kind of asking - it seems like we
have a very finite role in this, and the feds have a larger role. Can you just
kind of walk us through in a tight format what that relationship is? How much
influence do we have over the feds on this, especially when it comes to the
home care piece of that discussion?

MS. PEACH: Veterans Affairs Canada would determine the eligibility in
the programs and services that they offer to veterans. In some instances, they
deliver that service themselves or through other contracted relationships that
they might have with providers. In this particular instance, in relation to
long-term care, we happen to be one of the contracted service providers that
they utilize to provide long-term care. They've also entered into agreements
with us to provide other supports to veterans, like the recently announced
operational stress injury clinic. We do certainly provide that care on their
behalf.

Our ability to enter into conversations - this recent agreement was
an example. We certainly shared with them that we do have an opportunity in
terms of the capacity that we have at Camp Hill. We also shared with them the
current wait-list for long-term care placement in the province. While it's
improving, we do still have a wait-list for that service. So we have an
opportunity to engage in those conversations with them, but ultimately, it's
Veterans Affairs Canada that determines the programs that they offer to
veterans and the criteria and eligibility that are applied.

MR. STROINK: So for us trying to intervene in these things is a
pretty moot point when they have so many regulations and guidelines set in
place to take these veterans in. Is that a fair assessment?

MS. PEACH: Intervening in particular client situations - I think we
have two roles. One, to make them aware of a particular client situation if
they're not already aware, although most often they are because they've been
involved. The second, I think, is to ensure that they're aware of the other
options that we're able to provide that individual to meet their needs within
the provincial system.

MR. STROINK: So understanding how deep this relationship goes in
this situation, what kind of impact would there be to the Nova Scotia health
care system if Veterans Affairs Canada all of a sudden said, we're not
interested in paying for all these beds? How would that impact us?

MS. PEACH: Certainly right now, the financial contribution that they
make to us to operate those beds is not insignificant. It's $41 million across
the province for the Nova Scotia Health Authority to operate those beds on
their behalf. In addition to that, connected to it would be infrastructure and
staff and all of the supports that we have in place around those beds that we
provide, and also, the individuals that we're currently caring for within those
facilities. So we would certainly want that to be part of a planned
conversation if that was a decision that Veterans Affairs Canada wanted to make
so that we're able to plan and adjust as we need to.

MR. CHAIRMAN: Mr. Wilson.

MR. DAVID WILSON: This kind of follows well with the comments just
made. The province does have a major role to play, I believe, in advocating for
appropriate services for veterans because when a decision is made on the
federal level to allow someone into Camp Hill, it frees up funds on a
provincial level to care for residents who might need that. If they deny those
patients, then that responsibility falls on the provincial government through
home care, long-term care, whatever services.

We do have a huge role to play, and I hope your department, the
minister, and the Premier recognize that we can't sit idly by and allow the
federal government to renege on their responsibility when it comes to providing
services to veterans. It goes back almost to 2012 when the former Harper
Government indicated that they may potentially get out of the business of
providing care in long-term care facilities for veterans. I know no defined
answer or change has taken place yet, but who knows? You indicated it's $41.1
million just in the contract beds, and that's facilities all over the province.
If the federal government pulls out, that funding is going to be gone. We'll
have to recoup that, and that will put immense pressure on our budget
provincially.

Is the funding allocated when the bed is in use both for the
contract and for the - at Camp Hill, for example, are the funds allocated just
when that bed is in use, or is it for the total number that we have, the 476?

MS. PEACH: Veterans Affairs Canada actually has a mixed model for
the contract beds. For the beds, as part of the Nova Scotia Health Authority,
we receive an annual operating budget to operate on their behalf, and we
receive that set budget regardless of occupancy. There is some reconciliation
that they do with us at the end of the year, and that would be the same for the
long-term care facility in Springhill which is not ours but which they have a
contract with. Two of the facilities, St. Anne Community and Nursing Care
Centre and Wynn Park Villa, are based on an agreement where they provide a per
diem when the bed is utilized by a veteran. It is a mixed model that they have
in Nova Scotia.

MR. DAVID WILSON: In those facilities, for example, are we able to
gain access as a province to those beds when they're not utilized? From what I
recall, they have to stay vacant if there's no veterans in that region of the
province. Is that correct?

MS. PEACH: My understanding for those beds is that they would remain
vacant if not required by Veterans Affairs Canada. I can't speak for them
because we don't operate those particular facilities where the rate is on a per
diem basis. For the Nova Scotia Health Authority, I know we do have an
agreement with them that allows us to use the beds when they're not in use by
Veterans Affairs Canada. In those cases, we pay the per diem, and it is on a
transitional or temporary basis. As I said, we have used them for some of the
development work that has happened, and we've used them when we've needed space
to accommodate renovations and things like that. But again, it's when not
required by Veterans Affairs Canada.

MR. DAVID WILSON: If you could provide us that breakdown that you
mentioned, which ones are utilized and stuff, that would be appreciated.

Over the last six months, I'll say, has there been any discussion
within your department and with the minister's office on mitigation of
potential increasing costs, for example? What is going on? I think there's a
strong need for the province to advocate to the federal government to say,
listen, you need to live up to your commitment to our veterans. There's a
number of issues of the current veterans who can gain access to Camp Hill, as
we know from the media recently.

There's our current-day veterans. Look at the U.S. for example. I
think they do a better job of supporting current-day veterans who were in Iraq
or in Afghanistan. In Canada, that's a discussion I think we need to push
forward with, and provinces need to push that so that the federal government
can make a decision to say how we deal with the increase in veteran care that
we're going to see in 20 or 30 years. There are veterans today who are in their
late 20s, so they don't need nursing homes now; they don't need home care now.

Is there any discussion on a provincial level to say, listen,
federal government, you need to live up to commitments that you've made to
military personnel? What has transpired? Has the Premier been involved in any
discussion that you're aware of with your department to be a strong advocate to
wake the federal government up, to say, let's change how we're doing things? We
need to address a pending pressure on provincial services like home care and
long-term care with a new wave of current-day veterans, as most people would
call them.

MS. PEACH: I can't speak on behalf of the department or the province
in terms of conversations that might have happened with the federal government
in relation to the care of veterans. What I can say though as a service
provider - which the Nova Scotia Health Authority would be - we've certainly
had some discussion with them around transition as their needs change. The
unpredictability of the demands and needs of veterans is part of the challenge,
trying to anticipate what the needs may be looking into the future.

From a process perspective, as a service provider, we have annual
conversations with Veterans Affairs Canada as it relates to our budget. We have
those conversations directly with Veterans Affairs Canada, as they're
contracting with us to provide that service. We certainly let them know if
there are any pressures that we've identified.

The other point that you raised is in relation to the new veterans
and the services they may be needing. I think that's where you see us entering
into new relationships with Veterans Affairs Canada more in relation to mental
health and addictions and the supports that we're able to provide. The new
partnership that they've asked us to take on in relation to operational stress
injuries is a really good example of that. Whereas before our relationship with
them would have been focused predominantly on long-term care needs, and it
still is, we're also moving into those other conversations of support where we
can be a provider of that service on their behalf, which I think just
represents those changing needs and how we all need to change and adjust to the
population.

MR. CHAIRMAN: Next we have Mr. Orrell.

MR. ORRELL: I guess with the number of Second World War veterans
declining rapidly, there's talk that there are going to be some changes to the
criteria for admissions to Camp Hill. While the federal government is
conducting its review, is there anything that's been put in place in the
meantime for assistance or to help veterans who are now wishing to gain access
to Camp Hill while that review is going on?

MS. PEACH: There is not a specific review under way that I'm aware
of. Veterans Affairs Canada may be doing their own review, and I suspect we'll
be having conversations about their regulations. But in terms of what services
are provided, my understanding from Veterans Affairs Canada is veterans who
have an identified need for long-term care would go through the process of
being assessed by Veterans Affairs Canada. If they meet the eligibility as
determined by them for Camp Hill and they have that need, they would then be in
contact with us to determine what availability we have to provide that care to
the veteran.

MR. ORRELL: If someone needs access to care but was deemed by
Veterans Affairs Canada not to meet that criteria, they would still enter the
province's facilities for long-term care?

MS. PEACH: That's a good point of clarification. What would be
helpful is if they reached out to continuing care in the province to look at
what supports we might be able to provide. I would assume that if an individual
doesn't meet the care needs to be provided with care in a Veterans Affairs
Canada contract bed, it may be too early for them to explore admission to
long-term care, but there may be other supports that might be available as
well.

MR. ORRELL: I'm just trying to wrap my head around this. A veteran
needs care, Veterans Affairs Canada is going to take the time to provide that
care. I would like to see this committee maybe write the Minister of Health and
Wellness and/or the Veterans Affairs Minister, who is the Premier, to ask him
to allow these veterans who are either in need of care by assessment knowing
they need care before they can get approved by Veterans Affairs Canada to allow
them to use the services at Camp Hill because we're going to provide that
service anyway.

I guess I would move a motion to write the Minister of Health and
Wellness and the Premier to allow those veterans to use the veterans' services
at Camp Hill and for us to support that until Veterans Affairs Canada decides
if they're going to support it or not support it because we're going to end up
supporting it anyway. Why put a veteran through all that like Mr. Blindheim
went through, when they're going to need care anyway? It's going to be funded
by the province or the feds. I would move that motion if I could, Mr. Chairman.

MR. CHAIRMAN: Ms. Peach, do you want to comment on that first?

MS. PEACH: Maybe just a point of clarification. My understanding is
that the new agreement that we have with Veterans Affairs Canada around access
to Camp Hill will alleviate some of that. I think it's important to make sure
that we have an opportunity - we're two weeks into that new agreement with them
- to test out how that works in terms of providing access to veterans.

My hope is that it does provide access to a category of veterans
that we would have been challenged to provide that support to and that this
will provide some of that solution. We're certainly willing to work with
Veterans Affairs Canada to evaluate that need on a go-forward basis. I think
right now we don't even have a sense of what the demand for that new capacity
might be. But I suspect we'll get a better understanding of that soon, as
Veterans Affairs Canada is identifying veterans who are at the point where they
require that level of support and care.

MR. CHAIRMAN: We have a motion on the floor. Can you repeat the
wording of that motion?

MR. ORRELL: Just that we write a letter to the Minister of Health
and Wellness and/or the Premier, who's the minister for veterans affairs, to
allow the veterans who are trying to access this service at Camp Hill to be
considered for the service if the need is there, regardless of if Veterans
Affairs Canada is going to fund it early or not. If they're going without this
service until we decide, they're sitting at home and getting home care and
they're getting everything else that goes with it, so we're still spending the
money on the veteran - better off if they were in a long-term care facility
like Camp Hill.

MR. CHAIRMAN: We have to deal with the motion, of course, but can we
defer until after we finish the presentation? Are you okay with that?

MR. ORRELL: Yes, that's fine.

MR. CHAIRMAN: We'll deal with that after we conclude the questions.

Mr. Maguire.

MR. BRENDAN MAGUIRE: Thanks for coming today. I just wanted you to
clarify it a little bit. You just said, allow access to a category of veterans
that may not have had access. Can you elaborate on that?

MS. PEACH: Sure. The eligibility criteria that Veterans Affairs Canada
would have used to determine veterans who were appropriate for care at Camp
Hill was a set of eligibility criteria that they had very specific to contract
beds. There were other veterans who they supported in community-based
facilities across the province. My understanding of their approach in this new
agreement is that there would be that category of veterans who in the past
might have been able to access a community bed, who now would be able to access
a contract bed under this new agreement at Camp Hill.

MR. MAGUIRE: Which veterans would those be?

MS. PEACH: That would be for Veterans Affairs Canada to determine.

MR. CHAIRMAN: The last round, to Mr. Wilson.

MR. DAVID WILSON: I would be remiss not to mention a couple of the
veterans who have been trying to gain access. Of course, one name was mentioned
already, Mr. Alan Sagar. But there had also been Mr. Donald Osborne and Mr.
John Smith, who hopefully can find some comfort in the change or this new
agreement that has been signed with the federal government on the use of the
beds at Camp Hill.

I note that there are 13 beds, I believe, that are being used with
the move from Dartmouth General over to Camp Hill. We don't have to pay the
federal government for the use of those beds? We just utilize the beds that
were designated to be used by veterans, is that correct? There's no cost, per
se, to the federal government to use the beds that were designated as veterans
beds?

MS. PEACH: When we use the capacity that's unneeded by Veterans
Affairs Canada on a temporary basis, we are required to contribute toward the
per diem that ordinarily would have been paid by Veterans Affairs Canada. That
case - the very specific case in relation to Dartmouth General - is related to
a unit closure to allow redevelopment to happen at that site. So we would be
contributing to the cost of care for those individuals.

MR. DAVID WILSON: Just for clarification, that doesn't go to the
federal government. That just goes to pay for the individuals and to provide
the care - correct?

MS. PEACH: I wouldn't be able to speak to the details of the
specifics of the financial transaction. The easiest way to put it would be that
if there were a section of beds that we were utilizing for another purpose for
the course of the year, we wouldn't receive funding from Veterans Affairs
Canada for those beds because they weren't available to veterans.

MR. DAVID WILSON: I would hope we don't send any money to the
federal government. I mean, if they're denying access and there are beds
unoccupied and we're using them - I hope that's not what's happening.

My last question is on wait times for long-term care beds designated
for Veterans Affairs. Are those wait times and that list held solely with the
federal government, or does the province work with them in one of the
communities - the contract beds, for example - and say, okay, there's a bed
coming up? Is it solely the federal government's jurisdiction, or does the
province play a role in any kind of wait time?

So the question is, is there a wait time? And who oversees
controlling that and trying to make sure that those veterans get access?

MS. PEACH: My understanding, because we do have vacant capacity
across the province - overall, I would say there isn't a wait time, or not a
substantial wait time. We do have areas of the province and contract beds that
are fully occupied, and I understand that there is a bit of a wait-list for
service in that community.

The wait-list is maintained by Veterans Affairs Canada, and the
eligibility on that wait-list is determined by them. They also determine that
assessment for placement into the facility based on need, not necessarily based
on chronological order. The way the process works is, when we have a vacancy in
a contract bed, we notify Veterans Affairs of that vacancy and then they notify
us of the veteran who matches the need for that bed, and then we proceed with
the admission process.

MR. MACLEOD: Just a point of clarification - I just want to be sure
I understand this. According to your presentation, there are 150 beds at Camp
Hill; 13 of them are now being utilized by Dartmouth General and 12 of them are
unoccupied. That means there are 25 beds that are not being utilized. You do
not get any funding for those 25 beds if they're not utilized. Is that correct?

MS. PEACH: Just to clarify - and I appreciate that it is complex -
there are 175 contract beds at Camp Hill; 150 of those are currently occupied
by veterans, 13 are being utilized temporarily for individuals from Dartmouth
General, and 12 are vacant.

Traditionally, historically, we've continued to received funding
from Veterans Affairs regardless of whether the beds have been occupied by a
veteran or not. It's based on an annual budget, with the exception of the two
facilities that aren't Nova Scotia Health Authority facilities, which receive a
per diem from Veterans Affairs. So they only receive the funding if they're
occupied by a veteran.

In the case of Camp Hill, where we're utilizing a significant number
of those beds for the temporary care of individuals for a longer period of
time, there would be an adjustment to the budget acknowledging the fact that
they wouldn't be available to veterans during that period of time. Does that
help?

MR. MACLEOD: Yes, I think that's where we were trying to get before.

Right now, because there are 12 unoccupied beds, no veteran would be
impacted by the fact that 13 of the beds are being used by Dartmouth General.
Is that correct?

MS. PEACH: Right. We certainly have conversations with Veterans
Affairs if we are planning to utilize any of those beds for purposes other than
Veterans Affairs' needs. They give us a sense of what veterans might be in the
community who would be nearing placement options, and certainly if we were in a
position where we had no vacant capacity and a veteran was identified as
needing that care, then we would work to make that capacity available.

MR. MACLEOD: So at the end of the day, the veteran comes first.

MS. PEACH. Yes.

MR. CHAIRMAN: Thank you, Mr. MacLeod, and to the committee members,
thank you for all your questions today. I'll leave a few minutes for you to
make some closing comments, Ms. Peach.

MS. PEACH: Again, I just wanted to take the opportunity to thank you
for giving me the opportunity to come today. As I said, it's an honour and a
privilege to be able to provide this support - and again, not just in relation
to long-term care but also the other supports we provide, for instance through
the Operational Stress Injury Clinic.

I did want to take the opportunity to publicly thank the many staff,
physicians, and volunteers we have who provide care and support to veterans
each and every day. They find ways to honour the veterans in the care and
support they provide to us in what they do each and every day. So I did want to
take the opportunity to thank them for that.

MR. CHAIRMAN: Thank you for being with us today, and thank you for
all of the information that you've provided to the committee members.

We'll take a short recess and then we'll come back to do committee
business. We are now in recess for the next five or so minutes.

[2:50 p.m. The committee recessed.]

[3:03 p.m. The committee reconvened.]

MR. CHAIRMAN: Order, please. I call the meeting back to order.
Before we move on to the other agenda items, of course, we have a motion that
we have to deal with on the floor from Mr. Orrell.

I'm going to try the wording on this again: to write to the Minister
of Health and Wellness and the Premier to allow veterans in need of care to
access Camp Hill while awaiting approval from Veterans Affairs Canada. Is that
correct, Mr. Orrell?

I'm going to open the committee to discussion. We'll start with Mr.
Rankin.

MR. RANKIN: I would take the advice of the witness and not
presuppose the outcome of the agreement that was made in the review that
they're looking at, the regulation changes.

I would support a similar type of motion that asks for an update a
month or two from now. As you said, it has only been two weeks, and we don't
know the full details of what came out of that. I certainly don't want to let
the federal government off the hook and make the province pay for services
right away. It's federal jurisdiction to pay for these veterans. They deserve
it, but I do want to see the outcome of the agreement come through, and I don't
think anyone wants to jeopardize the outcome of that.

So I'm not going to support this particular motion, but if there's a
similar one that prompts some kind of an update on what transpired from that
agreement, then I would support that.

MR. CHAIRMAN: Thank you, Mr. Rankin.

Mr. Orrell, on the motion.

MR. ORRELL: The intent is not to let the federal government off the
hook. It's the fact that if a person needs nursing home care and they're a
veteran, they're going to get the care from the province regardless, that
they're going to be put into one of the province's care facilities. At least if
they were in the veterans hospital and had their assessment done, the people in
the hospital could advocate on behalf of the veteran to stay there. The
assessment would be done and it would determine if the person required the
services of a veteran or not, which would, in my opinion, put more pressure on
the federal government to come in with that funding.

We're going to support the senior, even if he's not a veteran - the
senior may need it, they're going to go to a nursing home anyway. There's a
cost to that. The same cost would be incurred if they get the services of Camp
Hill hospital, but they would get their assessment and they would get the
required services until the federal government decided. But the people who did
the assessment and determined if they did need it or not could then put
pressure on the federal government, which would alleviate the pressure on the
provincial government, because then they wouldn't be in a care facility that
the government's paying for.

MR. CHAIRMAN: Thank you, Mr. Orrell. Mr. Wilson.

MR. DAVID WILSON: Mr. Chairman, I'll support this motion. On the
premise of the timeline that we've seen the federal government act over the
last year or two, it's unbelievable to see a 94-year-old veteran fight to get
access to services for a year or more.

I know there are a number of veterans out there pending review and
pending assessment. The provincial government is receiving money for those
empty beds. Why don't we use them?

So I do support that motion, and I hope our colleagues would also.

MR. CHAIRMAN: Thank you, Mr. Wilson.

We have a motion on the floor. I'll now call for the vote.

Would all those in favour of the motion please say Aye. Contrary
minded, Nay.

The motion is defeated.

We will move on to the rest of the business of the agenda. Before I
move on to the next item on the agenda, which is correspondence, I do want to
recognize something that took place in the last sitting of the Legislature.
There are a number of members here on the committee who were part of that process,
and of course, that's the Registry of Motor Vehicles changes that helped our
military drivers transition into the private sector. I do want to thank and
congratulate the committee.

One of the best functions of this committee is that we work well together
to do what we can to support veterans, and because of that work and because of
that motion that came out of this committee, that certification was passed. So
on the record, I just want to thank the committee members who were involved in
that important discussion and, of course, the representatives who were in front
of the committee to push that on behalf of the veterans of the community.

I think it's important to recognize that that started at this
committee and that was passed. That's going to be a big help for some of our
veterans as they transition into private life.

We will now move on to correspondence. We have a number of pieces of
correspondence. The first one is from Tourism Nova Scotia, in regard to the response
to the letter from February 11th. I just want to put that on the
record, that we did receive correspondence from that.

Then we have the information requested from the March 10th
meeting for the Military Employment Transition Program. We received that
correspondence.

We had an invitation regarding Enemy in the Ranks: Systemic Racism
in the Canadian Forces discussion. That is also included in your package.

We also have correspondence from the Department of Health and
Wellness, the information requested from the October 22nd meeting.

Then we have the Military Employment Transition Program. That was
the conference that was held last month.

Finally, we have correspondence from the Honourable Alfie MacLeod
and a response from myself as the Chair.

That is the correspondence that I have on file. Are there any
questions or comments on that?

Mr. MacLeod.

MR. MACLEOD: Just in reference to our exchange of information, I
would like to make a motion that the committee ask for a report from the Health
Authority in three months' time on how the current process is working in
engagement for the veterans. I think it's fair to give it a chance, but I also
think it's important to do a follow-up and find out if the system is indeed
working. If not, it may be something that we want to revisit.

My motion would be that - and again, it can be in letter form. It
doesn't have to be a witness coming back. But I think there should be a
follow-up where in at least three months' time we get a report on how the new
system is working with the new agreement that was put in place on June 24th.

MR. CHAIRMAN: We have a motion on the floor. Is there any discussion
on the motion? Seeing none, I'll call for the vote.

Would all those in favour of the motion please say Aye. Contrary
minded, Nay.

The motion is carried. Thank you, Mr. MacLeod.

We have one more piece of business here that I want to deal with, so
just bear with me here for a second.

As you're aware, we did have one presenter that we've been trying to
reach out to for the last year, the Injured Soldiers Network, to come and
present in front of this committee. They were approved in the last
agenda-setting, and much credit to the Clerk, who over that period of time has
tried very hard to have the Injured Soldiers Network present. We have still not
received confirmation that they will come and appear before the committee, but
we do have a recommendation to have someone present in their absence.

Who we're looking at is the Canadian Institute for Military and
Veteran Health Research. "The health and well-being of Canadian military
personnel, Veterans and their families is maximized through world-class
research resulting in evidence-informed practices, policies and programs."
Instead of having the Injured Soldiers' Network present, in that slot we would
bring in the Canadian Institute for Military and Veteran Health Research.

Is the committee in favour of that change? Can I have a motion on
that?

MR. MAGUIRE: I'll so move.

MR. CHAIRMAN: Moved by Mr. Maguire.

Would all those in favour of the motion please say Aye. Contrary
minded, Nay.

The motion is carried.

The next meeting date will be September 20, 2016. We have Dr. Maya
Eichler on veterans research on September 20, 2016.

That concludes our business. We are adjourned. Thank you all for
your participation.

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